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At least 991 records · Page 55Linked to original sources
PubMed2001

Spatial awareness in urologists: are they different?

OBJECTIVE: To compare innate spatial awareness skills, using the MIST-VR system (Ethicon Ltd, Edinburgh, a computer-based virtual reality system that objectively tests spatial awareness) among three groups of people (consultant urologists, urological trainees and controls who were not surgeons), because urological surgeons require spatial awareness for endoscopic and laparoscopic surgery, but trainees are selected by academic prowess rather than surgical aptitude. SUBJECTS AND METHODS: The MIST-VR system was used to test 122 volunteers in three groups, i.e. 39 consultant urologists, 46 urological trainees and 37 controls (not surgeons). The demographic data recorded for each group included age, sex, eyesight, handedness, and endoscopic and laparoscopic experience. Volunteers performed a repetitive series of three tasks using the system. Their performance was measured in terms of time, errors and economy of movement, as well as the duration and accuracy of diathermy in Task 3. RESULTS: The consultants were significantly older than the trainees and controls (both P<0.001) and had more endoscopic experience (P=0.005). In Task 1, the trainees made significantly fewer errors (P=0.045) and had a greater economy of movement (P=0.03) than the controls. In Task 2 the trainees performed the task more rapidly than the consultants (P=0.04) and controls (P=0.02). Trainees were more economical in movement than were consultants (P=0.031) and controls (P=0.046). In the more complex Task 3, trainees outperformed consultants in terms of errors (P=0.03), economy of movement (P=0.046), total diathermy time (P=0.005) and diathermy error (P=0.03). Controls performed similarly to the consultants. Although there was a trend towards better performance by trainees over controls, this was only significant for time (P=0.04) and total diathermy time (P=0.011). A few participants had results that were >2 SD above the mean and several people could not complete Task 3. CONCLUSIONS: Urologists do not differ from the general population in terms of innate spatial ability in this setting. There are several people who may have a defect in spatial awareness but the incidence was the same in each group. Urological trainees outperformed consultants in these tasks; the reasons for this are unclear. The MIST-VR system is of no help in aptitude testing for urological trainees, although it may have a role in teaching laparoscopic surgery. Testing other psychometric components may be more important for acquiring surgical skills than innate spatial-awareness skills. Further studies are required to investigate this possibility.

Adult↗
PubMed2003

[Modern treatment options for Zenker's diverticulum: indications and results].

Conventional transcervical therapy of Zenker's diverticulum comprises diverticulectomy, invagination, diverticulopexy and myotomy, which may be combined with the aforementioned methods. Transoral diverticuloesophagostomy is performed by diathermy, lasers or staplers through a rigid esophagoscope, or more recently by diathermy applied via a flexible endoscope. Morbidity of transcervical procedures ranges between 3 (myotomy) and 23 % (diverticulectomy + myotomy). The percentage of patients with at least significantly improved symptoms is 92 % or more, while recurrences occur in 5.7 (diverticulectomy alone) to 21 % (invagination). Transoral procedures have a morbidity of 9 (stapler) to 26 % (Laser), while symptoms improve in 91 (diathermy through rigid esophagoscope) to 99 % (diathermy via flexible endoscope), however in up to 64 % of patients reoperations are necessary. Small diverticula (Brombart I/II) can be treated by diverticulectomy (with/without myotomy) or flexible endoscopy, larger diverticula in general by all methods. Patients younger than 60 years should undergo diverticulectomy, elderly multimorbid patients should be treated by transoral procedures.

Electrocoagulation↗
PubMed2003

Ovarian stromal blood flow changes after laparoscopic ovarian cauterization in women with polycystic ovary syndrome.

BACKGROUND: Women with PCOS have significant differences in intra-ovarian and uterine artery haemodynamics. The aims of this study were to compare the ovarian stromal blood flow before and after laparoscopic ovarian diathermy, and to evaluate the value of these parameters in predicting the outcome of treatment in women with polycystic ovaries. METHODS: Colour Doppler blood flow within the ovarian stroma was recorded and serum concentrations of FSH, LH and testosterone were measured in 52 women with polycystic ovaries before and after laparoscopic ovarian diathermy. Ovulation was evaluated by folliculometry and progesterone assay in the first menstrual cycle after operation. RESULTS: Six to 10 weeks after the diathermy, serum concentrations of LH and testosterone decreased significantly (P = 0.001). The mean +/- SD peak systolic velocity decreased from 14.04 +/- 6.28 to 12.49 +/- 6.32 cm/s (P = 0.001), pulsatility index increased from 0.98 +/- 0.36 to 1.78 +/- 0.72 (P = 0.001), and resistance index increased from 0.55 +/- 0.16 to 0.71 +/- 19 (P = 0.001). A total of 73% of the women ovulated. There were significant negative correlations between pulsatility index and LH (r = -0.43, P = 0.001), pulsatility index and testosterone (r = -0.40, P = 0.003) and pulsatility index and LH/FSH ratio (r = -0.53, P = 0.001). CONCLUSIONS: Laparoscopic ovarian diathermy in women with polycystic ovary syndrome may result in a decrease in ovarian stromal blood flow velocity. There was a significant correlation between hormonal and ovarian stromal blood-flow changes. Changes in the Doppler parameters were significantly higher in women who ovulated. The measurement of ovarian stromal blood flow by colour Doppler may be of value in predicting the outcome of treatment.

Adult↗
PubMed2005

Instrumentation and patient characteristics that influence postoperative haemorrhage rates following tonsil and adenoid surgery.

OBJECTIVES: To investigate the effect of the type instrumentation used and the age and gender characteristics of patients on postoperative haemorrhage rates following tonsil and adenoid surgery. DESIGN: A retrospective analysis of 13 593 procedures was performed from The Patient Episode Database for Wales between 1 January 1999 and 31 March 2004. SETTING: National health policy changes created four periods of different instrument usage (reusable, single-use with diathermy, single-use alone, specified single-use with diathermy). These and the age and gender distribution of the patients were examined against four categories of postoperative haemorrhage. MAIN OUTCOME MEASURES: Postoperative haemorrhage rates were expressed as the number of complications per operations performed. Primary postoperative haemorrhage that occurred during the initial admission either required a return to theatre [R1] or was managed conservatively [N1]; secondary postoperative haemorrhage that required a return to hospital either returned to theatre [R2] or was managed conservatively [N2], were compared. RESULTS: Primary haemorrhage with return to theatre doubled, from the baseline rate with reusable instruments, from 0.6% (CI 0.5-0.8) to 1.2% (CI 0.7-1.9) when single-use instruments were introduced and remained high at 1.4% (CI 0.9-2.1) after the withdrawal of single-use diathermy. This haemorrhage rate returned to the baseline rate (0.6% CI 0.3-1.0) when specified single-use instruments were introduced. None of the other haemorrhage rates changed significantly throughout the four observation periods. Adenotonsillectomy and tonsillectomy patients have different age and gender patterns. In a univariate analysis, males over the age of 12 years were twice as likely to have haemorrhage with return to theatre than girls of the same age, 3.8% (CI 3.0-4.7) versus 1.7% (CI 1.4-2.1). CONCLUSIONS: A significant rise in serious postoperative primary haemorrhage but not secondary haemorrhage was seen following the initial introduction of single-use instruments that reverted to baseline with the introduction of specified single-use instruments. Diathermy does not appear to have affected the haemorrhage rates. There is a distinct age and gender pattern for tonsil and adenoid surgery and risk of postoperative haemorrhage. The use of arbitrary divisions of age may be misleading in studies that examine post-tonsillectomy haemorrhage.

Adenoidectomy↗
PubMed1994

Rollerball endometrial ablation: a histological study in danazol pretreated patients.

Endomyometrial biopsies were taken from danazol pretreated patients about to undergo rollerball endometrial ablation for menorrhagia. The biopsies were taken with a loop electrode at hysteroscopy before and after 1, 2, 3 passes of a rollerball electrode over the endometrium using powers of electrocoagulation diathermy varying from 30 to 100 watts. The biopsies were then assessed histologically. Nineteen biopsies from the perceived endocervical canal, 25 posttreatment curettings and 3 hysterectomy specimens were also assessed. Biopsies taken after danazol pretreatment but before diathermy showed a thinned inactive endometrium. A histological classification of the effect of electrocoagulation diathermy on the endometrium was developed describing increasing endometrial damage. The degree of endometrial damage was directly related to the number of rolls of the ball over the endometrium and to the power of electrocoagulation diathermy. Endometrium was found in 84% of biopsies from the perceived endocervical canal and endometrium was found in curettings from 3 of 11 patients who were amenorrhoeic following ablation.

Adult↗
PubMed2001

Early pregnancy is elusive and robust.

We describe a live birth occurring following bilateral ovarian diathermy, hysteroscopy and dye test in women with clomiphene citrate resistant polycystic ovarian syndrome performed inadvertently during early pregnancy. A woman with polycystic ovarian syndrome resistant to Clomiphene citrate had bilateral laparoscopic ovarian diathermy performed inadvertently during early pregnancy. The patient was treated by Clomiphene citrate for 12 cycles then she had bilateral laparoscopic ovarian diathermy and hysteroscopy and dye test. Pelvic ultrasound examination, serum beta hCG, serum LH, FSH, Prolactin, T, SHBG, DHAS and serum E2 level. Successful outcome of pregnancy following bilateral laparoscopic ovarian diathermy and hysteroscopy and dye test inadvertently performed during early pregnancy. That all women scheduled for elective pelvic surgery should be advised to use effective contraception or avoid unprotected sexual intercourse in the preceding month as well as having an hCG test prior to surgery to exclude pregnancy.

Adult↗
PubMed2004

Stapled haemorrhoidectomy in Chinese patients: a prospective randomised control study.

OBJECTIVE: To compare stapled haemorrhoidectomy with open diathermy haemorrhoidectomy in Chinese patients with respect to the postoperative pain, symptom control, and manometric alterations. DESIGN: Prospective randomised controlled trial. SETTING: A regional general surgical unit, Hong Kong. PATIENTS: Twenty-four patients with second- or third-degree haemorrhoids or who have had failed medical treatment. INTERVENTION: Open diathermy haemorrhoidectomy or stapled haemorrhoidectomy. MAIN OUTCOME MEASURES: Structured questionnaire for symptoms, anorectal manometry, transrectal ultrasound, and postoperative pain. RESULTS: Stapled haemorrhoidectomy compared with open diathermy haemorrhoidectomy resulted in similar postoperative pain and drug requirements. Postoperative control of prolapse symptoms was significantly better with open diathermy haemorrhoidectomy than with stapled. The control of other symptoms was similar with regard to bleeding, pain, pruritus, and incontinence scores. Anorectal manometry showed a decrease in the maximum resting pressure and maximum squeeze pressure in both groups, but the decrease was only significant in the stapled haemorrhoidectomy group. CONCLUSIONS: Stapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy for the treatment of haemorrhoids, but with the exception of skin tag prolapse. There is a need for long-term follow-up for the changes in manometric parameters after haemorrhoidectomy.

Adult↗
PubMed1975

The effect of electrical epilation on the bear hair of women with idopathic hirsutism.

The influence of epilation by means of diathermy and galvanic current on the hair roots in the beard region of 11 women with idiopathic hirsutism has been investigated. The hair-roots could be destructed by both methods. Various differences were found between the two methods: 1. After 10 weeks, the hair density in the field treated by diathermy was lower than that in the corresponding field treated with galvanic current. However, the time required for total destruction of all hair roots was found to be the same for both methods. 2. The diameter of the hairs growing again after diathermy was found to be less than that after galvanic current, while the proportion of dysplastic/dystrophic hairs was significantly greater.

Adult↗
PubMed2005

Percutaneous coagulation of choroid plexus to unblock the ventricular catheter using the Seldinger technique: preliminary report.

BACKGROUND: Blockage of the ventricular catheter is the most common reason for shunt malfunction and is usually due to ingrowth of choroid plexus into the catheter lumen. The authors describe a simple technique to unblock the ventricular catheter in situ. METHODS: In children with symptoms and radiological evidence of shunt malfunction, the Rickham reservoir was tapped under a general anesthetic. Manometry with saline was performed to confirm isolated proximal blockage of shunt. A guide wire, insulated to the scalp, was passed into the ventricular catheter using the Seldinger technique. Bursts of monopolar diathermy were applied to the guide wire to coagulate choroids plexus and manometry was repeated. In this preliminary study, all ventricular catheters were subsequently revised. RESULTS: This percutaneous technique was undertaken in 7 children with confirmed proximal shunt malfunction. Successful unblocking of the ventricular catheter was established by increased flow of cerebrospinal fluid around the guide wire. The mean +/- SEM manometry reading post-diathermy (21.9 +/- 5 cm) was higher than the pre-diathermy value (0.6 +/- 0.6 cm; P < .01). CONCLUSIONS: Percutaneous coagulation of the choroids plexus using the Seldinger technique is a simple, inexpensive, minimally invasive method to unblock ventricular catheters and it may be suitable as a stand-alone technique in selected patients.

Adolescent↗
PubMed1996

Argon-enhanced cutting and coagulation confers advantages over conventional electrocautery for mastectomy.

In this prospective randomized study we have compared argon-enhanced electrosurgery with conventional diathermy in a consecutive series of 50 patients undergoing mastectomy. The groups were comparable in age, menopausal status, tumour size, stage and specimen size. Patients undergoing mastectomy using argon diathermy had significantly less blood loss intraoperatively (521 (67)ml vs 824 (59)ml; P<0.001) and a significantly lower transfusion requirement post-operatively. There were no significant differences in post-operative drainage (1350 (160) ml vs 1527 (169) ml; P=NS), length of hospital stay, incidence of seromas or other complications. Argon diathermy significantly reduces intraoperative blood loss and should be considered as the method of choice in patients undergoing mastectomy.

Argon↗
PubMed1981

United States radiation safety and regulatory considerations for radiofrequency hyperthermia systems.

The control of Radiofrequency (RF) radiation (including microwave radiation) that is emitted by therapeutic medical devices is the responsibility of the Food and Drug Administration's (FDA) Bureau of Radiological Health (BRH). Several studies of RF emissions from various shortwave (27 MHz) and microwave (2450 MHz) diathermy devices have been conducted by the Electromagnetics Branch of the Bureau's Division of Electronic Products. BRH studies have led to a proposed standard for microwave diathermy devices operating above 900 MHz. Shortwave diathermy devices used in physical therapy situations have been found to produce relatively high levels of unintended exposures (sometimes exceeding present U.S. exposure standards) to device operators and to the nonprescribed tissues of the patient. BRH is initiating further studies to ascertain the need for controls to be placed on these shortwave devices to ensure safety and medical effectiveness. Radiation safety standards, which presently exist in the United States, allow much higher unintended human exposures than do the standards existing in the several eastern European countries. A trend to lower permissible exposures to 5 mW/cm2 or even 1 mW/cm2 is under way in the U.S. The various provisions of FDA's Medical Device regulations apply to investigational as well as commercially-marketed RF/microwave devices and require both safety and medical effectiveness aspects of performance to be addressed by their manufacturer. A set of microwave radiation safety considerations has been developed by BRH for newly emerging cancer therapy protocols which utilize microwave hyperthermia devices.

Diathermy↗
PubMed1976

Electromagnetic field interference and cardiac pacemakers.

The physical and physiological effects of electromagnetic field interference on 440 patients with cardiac pacemakers were determined by reviewing the literature from 1949 to 1973. The sources, mechanisms, and findings of physiological dysfunction and ventricular fibrillation in patients with pacemakers are presented. Shortwave and microwave diathermy and electrical stimulators have been found to have a definite adverse influence on some cardiac pacemakers. The effect of interference may be an increase or decrease in pacemaker rate or rhythm, ventricular fibrillation, a total loss of pacing, or cessation of impulses. Because all pacemaker units are not resistant to interference, no ungrounded electrical equipment and no equipment such as microwave diathermy, short wave diathermy, and electrical stimulators should be placed on, or near, a patient with a cardiac pacemaker.

Diathermy↗
PubMed1979

The use of 2450 megahertz of microwave in cancer therapy; a pilot study.

Contraindications to microwave diathermy traditionally include malignant tumors. This paper describes a pilot study of tissue hyperthermia treatment (average 42.5 degrees C, 108.5 degrees F) for superficial cancers, using 2450 megahertz of microwave diathermy. Tissue temperatures were recorded for prolonged periods of time, and tumor responses to heat alone, or to heat combined with radiation therapy, were observed. Such treatments were tolerated by the patients, but were not without side effects. Preliminary results of this pilot study, as well as those of other investigators, showed that tissue hyperthermia would be a useful treatment modality for cancer therapy. The familiarity of physical therapists with microwave diathermy may be an asset to them as clinicians. Physical therapists, however, should not attempt to treat cancer patients alone. Further clinical research in the area should be conducted in the proper setting under the guidance of an oncologist.

Body Temperature↗
PubMed1980

Results and complications of surgery of retinal detachment with a macular hole.

About 96% of retinal detachments with a macular hole were cured by surgery. The most effective surgical procedure was diathermy with a macular buckling method and scleral infolding at the temporal part of the equatorial region, the rate of success being 100%. Only diathermy or diathermy plus scleral infolding at the temporal part of the equatorial region could reattach all detached retinas. Since macular buckling procedures made visual acuity worse, techniques without macular buckling should be used in cases without macular atrophy or degeneration of myopia. Retinal hemorrhage during or after operation was the most frequent complication (50%) of surgery for retinal detachment with a macular hole and occurred more frequently when macular buckling procedures were used. Macular hemorrhage caused deterioration of postoperative visual acuity.

Adolescent↗
PubMed1997

Comparison of carbon dioxide and neodymium: yttrium-aluminum-garnet lasers in surgery of the inferior turbinate.

At the Department of Otorhinolaryngology-Head and Neck Surgery of the University of Kiel, 533 patients with hyperplastic inferior turbinates were treated between 1987 and 1994 with various carbon dioxide (CO2) and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser techniques. We report on the therapeutic results of both types of laser turbinectomy and compare their long-term results with those of submucosal diathermy. Among the different techniques, we preferred the following approaches. The CO2 laser technique involved the application of a few laser spots (laser energy density 6,100 J/cm2 per lesion) to the head of the turbinate under the operating microscope. In the Nd:YAG laser procedure, diffuse, low-power irradiation (laser energy density < 53 kJ/cm2) of the entire concha was performed under endoscopic control. The CO2 laser procedure involved little bleeding and hardly any pain. It produced a positive effect after only a few days and required no follow-up treatment. The success of Nd:YAG laser treatment, by contrast, only became evident after weeks or months, due to the slow scarring process. Compared to submucosal diathermy, both laser methods produced better long-term results. Two years postoperatively, the overall success rate, as defined by patient satisfaction, was 79.6% for the CO2 laser, 68.3% for the Nd:YAG laser, and 36% for submucosal diathermy.

Adult↗
PubMed1975

Temperature distribution produced in models by three microwave applicators at 433.92 megahertz.

Temperature distributions produced in phantom models by diathermy applicators operating at a frequency of 433.92 MHz, a frequency not approved for diathermy by Federal Communication Commission regulations, and an experimental cooled contact applicator operating at an assigned frequency of 915 MHz were compared. The specially designed direct contact applicator with surface cooling elevated deep muscle temperatures as effectively as the "Rundfeldstrahler" operating at the lower frequency in spite of the better penetration of the energy at the lower frequency. The "Pyrodor" and the "Langfeldstrahler," the largest of the applicators operating at 433.92 MHz, do not appear to offer any advantage over existing diathermy equipment. The highest temperatures produced with these applicators were at the fat-muscle-interface.

Adipose Tissue↗
PubMed2003

Reusable versus disposable instruments in tonsillectomy: a comparative study of outcomes.

Tonsillectomy, traditionally performed using reusable instruments (RIs), has recently been performed using disposable instruments (DIs), to prevent the theoretical risk of spreading new variant Creutzfeldt-Jakob disease. Following this, there have been concerns of increased risk of complications, especially haemorrhage. We audited our hospital's complication rates of 100 tonsillectomies performed using RI and 100 using DIs. We analysed the overall complication rates and the postoperative haemorrhage rates. and compared them with the broader groups of RIs versus DIs. We also compared patients who did not have diathermy with those who did have diathermy. The overall complication rate was 6% with RIs and 33% with DIs and the haemorrhage rate was 1% and 12%, respectively. With DIs, these rates were significantly higher in the diathermy subgroup. We believe this is the first study to look at the complications due to DIs.

Adolescent↗
PubMed1977

An experimental study on endoscopic papillotomy in monkeys.

Endoscopic papillotomy would appear to have distinct advantages in non-operative treatment of common bile duct stones. To investigate the effects of this procedure on the papilla and adjacent organs, diathermy papillotomy was performed at laparotomy in three monkeys. White-cell count and levels of liver function parameters temporarily increased during the follow-up period of twelve months, suggesting that diathermy papillotomy might have brought about some pathological changes in the hepatobiliary system of monkeys, whereas no definite evidence of cholestasis or pancreatitis were noticed, and an excellent condition of papillotomy orifice and adjacent ogans was revealed at autopsy about 1 year after diathermy papillotomy.

Ampulla of Vater↗